All patients enrolled with the WFHT Family Practice or receiving services through the WFHT Team Care Centre are required to complete consent forms addressing their Personal Health Information. These consent forms are designed to ensure you understand and can provide informed, explicit consent regarding how your personal health information (PHI) is collected, used, and disclosed.

Patients are asked to review the appropriate form carefully before completing it. If assistance completing any of these forms is required, please contact us at (519) 250-5656 (press 1 for Family Practice or 2 for Team Care Centre), or visit our office in person and our medical reception staff will assist you.

The ‘Personal Health Information (PHI) Directive’ form outlines patient’s consent for care and explains situations where consent may not be required. It also allows patients to set a ‘consent directive’, granting general consent or limiting consent with specific restrictions.

You may also choose to:

• delegate decision-making authority to a trusted individual (family, friend, or other)
• authorize sharing your PHI with a designated person (family, friend, or other) for selected purposes, such as:
  • schedule or cancel appointments
  • receive appointment reminders
  • pick up records or documents (with valid ID)
  • discuss health information (diagnoses, medications, treatment)
• indicate your preferences for communication, including detailed voicemail messages and email correspondence.

The ‘PHI Directive – Substitute Decision-Maker’ Form is to be completed by an individual authorized to make decisions on behalf of a patient who is not capable of making their own decisions. It outlines who may act as a substitute decision-maker (SDM), including but not limited to:

• parent of the patient
• authorizes decision-maker
  • Substitute decision-maker under the Health Care Consent Act, 1996 – for decisions about:
    • Medical treatment
    • Admission to a care facility
    • Personal assistance services
  • Guardian of the person or property
  • Power of attorney for personal care or property
  • Representative appointed by the Consent and Capacity Board
  • Spouse or partner
  • Child, custodial parent, or Children’s Aid Society
  • Access parent
  • Brother or sister
  • Other relative

The form also outlines requirements for confirming authority, noting that proof—such as a court order or separation agreement—may be required where applicable.  It includes consent for care, outlines situations where consent may not be required, and allows the SDM to indicate communication preferences, such as consenting to detailed voicemail messages and email contact.

The ‘PHI Directive – Withdrawal of Consent’ Form allows you to withdraw or modify your previously provided consent regarding the collection, use, or disclosure of your personal health information. It ensures your preferences are updated and respected moving forward.